Written Assembly Questions tabled on 10 March 2016 for answer on 17 March 2016

R - Signifies the Member has declared an interest.W - Signifies that the question was tabled in Welsh.(Self-identifying Question no. shown in brackets)

Written Questions must be tabled at least five working days before they are to be answered. In practice, Ministers aim to answer within seven/eight days but are not bound to do so. Answers are published in the language in which they are provided, with a translation into English of responses provided in Welsh.

What arrangements are in place to ensure that there are adequate GP services available for the residents of care homes in Wales? (WAQ70032)

Answer received on 22 March 2016

The Minister for Health and Social Services (Mark Drakeford):

The two-year agreement we reached with GPC Wales about changes to the GP contract for 2015-16 and 2016-17 included a commitment to review the GP enhanced service for care homes.

Discussions with GPC Wales and health boards are currently ongoing to agree a new directed enhanced service for care homes which seeks to deliver best-evidence treatment and services based on individual need; maximise the continuity of care; minimise the need for unscheduled care and minimise the risk of poly-pharmacy.

What consideration has the Welsh Government given to the adverse impact of pacemakers on dignity in end-of-life care? (WAQ70033)

Answer received on 22 March 2016

Mark Drakeford:

Palliative care staff work with cardiology departments to ensure compassionate and supportive care is provided to people with implantable devices and their families at end of life to avoid inappropriate treatment.

People experiencing heart failure may be offered implantable pacemakers or defibrillators (ICD) to treat life-threatening arrhythmias. People with end-of-life heart failure may develop complex arrhythmias, which trigger firing of the ICD creating shocks that may be painful, hinder sleep and cause distress to them and their family. In these circumstances it may be inappropriate to retain the ICD in active defibrillation mode.

At the end of life the ICD may be turned off at the individual's request to reduce distress for themselves and their families and help them remain comfortable. Turning off a pacemaker is also possible and is non-invasive.

The Welsh Government is considering clinical guidance by the British Heart Foundation relating to the deactivation of implantable defibrillators. This will feed into the planned refresh of the End-of-Life Care Delivery Plan, which sets out how people and their families will be supported at the end of their lives, providing high-quality, and compassionate care in all settings for people of all ages. The plan emphasises the importance of listening to and respecting individuals' wishes and those of their family and carers.